70例免疫球蛋白辅助治疗老年脓毒症患者效果的研究  

Study on the treatment effect of immune globulin adjuvant therapy in 70 old sepsis patients

作　　者：李虎明 韩志海 陈旭昕 孟激光 李泳群 张燕[1] 张春阳[1] 陈韦 LI Huming;HAN Zhihai;CHEN Xuxin;MENG Jiguang;LI Yongqun;ZHANG Yan;ZHANG Chunyang;CHEN Wei(Department of Pulmonary and Critical Care Medicine,The Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心呼吸与危重症医学科,北京100048

出　　处：《转化医学杂志》2022年第2期76-80,共5页Translational Medicine Journal

基　　金：军队后勤科研计划重点项目(BHJ16J011);原海军总医院创新培育基金(CXPY201902)。

摘　　要：目的 探讨免疫球蛋白辅助治疗老年脓毒症患者的疗效,研究死亡患者的临床特征,分析临床指标对患者预后的预测价值。方法 选取2017年1月-2020年5月解放军总医院第六医学中心诊治的140例老年脓毒症患者,常规治疗+免疫球蛋白治疗70例为研究组,常规治疗70例为对照组,评估免疫球蛋白治疗效果及治疗前后临床指标情况。根据患者28 d预后情况分为存活及死亡两亚组,采用受试者工作曲线(ROC)评价临床指标对患者预后的预测价值。结果 研究组与对照组患者一般情况差异无统计学意义(P>0.05);研究组28 d死亡率下降,但与对照组比较差异无统计学意义(P>0.05);免疫球蛋白辅助治疗能更好的降低C反应蛋白(CRP)等炎性指标,差异有统计学意义(P<0.05);存活和死亡亚组患者临床指标单因素分析,结果示SOFA、APACHE Ⅱ、乳酸(Lac)、降钙素原(PCT)和血小板差异有统计学意义(P<0.05);多因素logistic分析示SOFA、APACHE Ⅱ和Lac是影响预后的独立危险因素;将预测值纳入受试者工作曲线(ROC),结果显示曲线下面积(AUC)为0.854,95%置信区间为(0.789~0.919)。结论免疫球蛋白辅助治疗老年脓毒症患者的死亡率下降,但差异无统计学意义;SOFA、APACHE Ⅱ和Lac对患者预后预测效能较好。Objective To explore the effect of immune globulin used as an adjuvant therapy medicine in the treatment of old sepsis patients, study the clinical characteristics of the dead patients, and analyze the predicted value of the clinical factors to the patients’ prognosis. Methods A total of 140 old sepsis patients admitted to our RICU from January 2017 to May 2020 were enrolled in our study. All of the patients were randomly divided into the control group and experiment group with 70 cases in each group. Patients in the experiment group were treated with general treatment with immune globulin adjuvant therapy while the patients in the control group were treated with general treatment only,the effect of immune globulin adjuvant therapy was estimated, and the change of clinical factors was collected at the same time. According to the status after 28 days, patients in the experiment were divided into survival group and death group. Logistic regression was performed to build the predictive model and the receiver operating characteristic(ROC)curve was used to test the model performance. Results For the basic situation, there was no significant statistical difference between the control group and the experiment group(P>0.05). The experiment group showed a lower death rate though there was no significant statistical difference(P>0.05). Taking immune globulin as an adjuvant treatment was conducive to inhibiting the inflammatory factor, like CRP, and there was a significant statistical difference(P<0.05).Univariate regression between the survival group and death group showed that SOFA score, APACHE Ⅱ score, Lac,PCT, and blood platelet had a significant statistical difference(P<0.05). Multivariable logistic regression showed that SOFA score、APACHE Ⅱ score and Lac were independent risk factors of prognosis. When the predicted value was enrolled into ROC, the area under the curve(AUC) was 0.854 with 95%CI(0.789~0.919). Conclusion Immune globulin as an adjuvant therapy tends to decrease the death rate, but no significant

关 键 词：脓毒症 脓毒性休克 肺炎 免疫球蛋白 老年 ROC曲线 

分 类 号：R459.7[医药卫生—急诊医学]